Skin Barrier Repair Moisturizers

How the skin barrier works

Skin Barrier Repair products are the best moisturizers to treat dry skin and eczema. However, there are many types of moisturizers – so why are skin barrier products better than other kinds of moisturizers to hydrate skin? Before we can explain why barrier creams such be used to treat dry skin, you can read here about what the skin barrier is, and you will understand why it is critical to have ceramides and other lipids in skin care to treat dry skin on the face and body.

How long does it take to repair the skin barrier?

Using a barrier repair moisturizer results in restoration of the skin barrier in 14 days.1 However, there are many factors that affect how long it takes the skin barrier to be repaired. Moisturizers with the correct ratio of lipids will repair the skin barrier. How much time it will take to repair the skin barrier depends upon what moisturizer you use, what caused the underlying skin barrier defect, and what habits you have that disturb the moisture barrier. To restore the skin barrier fast, you must make sure you have removed any skin care products that compromise the barrier and other causes of barrier disruption from your skin care routine. 

To learn more about the science of the skin moisture barrier, click here.

What is skin barrier cream? 

A skin barrier cream has lipids that mimic the skin’s natural skin barrier structure. The lipids must be the correct type, shape and number so they match the skin’s intricate multilamellar structure. Dry skin has tiny holes in the multilamellar membranes that surround skin cells. This allows water to evaporate off the skin, leaving the skin dehydrated and unprotected from allergens, irritants and microbes. Skin barrier creams replace lost lipids in the skin- which is similar to plugging holes in the skin- to keep the skin watertight.

How the skin barrier works

Barrier repair moisturizers are cream moisturizers that contain lipids that mimic the natural multilamellar structure of cell membranes. Barrier repair creams must contain all 3 of the skin barrier repair ingredients: fatty acids, cholesterol and ceramides.

What lipids plug the holes in the skin barrier

What barrier repair technologies should you look for in skin care products?

Some products claim to have barrier repair ingredients, but it is not apparent by reading the label if they have the correct ratio of lipids for optimal skin hydration. Look for these ingredient names on the label: 

  • PSL technology®, which has ceramide 3, cholesterol stearic and linoleic acid in the proper ratios.
  • MLE technology®, which has a pseudoceramide complex called myristoyl/palmitoyl oxostearamide/arachamide MEA combined with cholesterol and fatty acids.
  • Multisal neolipids® contains a ceramide called hydroxypropyl bispalmitamide MEA, linoleic acid, palmitic acid, and glyceryl stearate (a source of stearic acid). This technology is found in Epiceram®, which is a prescription barrier repair moisturizer.

What barrier moisturizers to use

How do you know if a barrier repair moisturizer is good?

If the barrier repair cream has the technologies mentioned above, then it has good research to back it up. If the moisturizer does not have these barrier repair technologies, and the label does not specify if it has ceramides, fatty acids, and cholesterol – how do you know if the moisturizer has the right ratios? We analyze a moisturizer’s ability to repair the skin barrier by looking at it under a microscope using cross-polarized light. When the moisturizer is able to recreate the 3D multilamellar structure of the skin barrier, anisotropy will be seen in a maltese cross pattern.2

Moisturizers that mimic the natural lipid barrier structure exhibit a maltese cross pattern.

Which moisturizers have a maltese cross pattern under the microscope?

These skin care products use barrier repair technology that exhibits a maltese cross pattern:

Medature PSL Repair Moisturizer

Zerafite Barrier Repair Moisturizer

Zerafite Soothing and Calming Moisturizer

Zerafite Body Cream

Skin Barrier Repair Ingredients

Dermatologist Dr. Peter Elias and his team3 first described how to use lipids to restore the skin barrier.4 Since then, there have been many moisturizers that claim to use lipids to restore the skin barrier- however- very few barrier repair moisturizers contain the correct lipids in the correct ratio to restore the skin barrier.

What is the correct ratio of barrier repair ingredients for optimal barrier repair?

As demonstrated by many studies7 the best ratio of lipids to restore the skin barrier is 1:1:1 (ceramides: fatty acids: cholesterol in equal amounts). Using the wrong ratio of ceramides, cholesterol and fatty acids actually injures the skin barrier and delays repair.8 In other words, if the moisturizer has more ceramides than fatty acids and cholesterol, or more fatty acids than ceramides and cholesterol, the moisturizer will injure the skin barrier.9This means that the barrier repair cream must have the same amount of ceramides as fatty acids and as cholesterol. There is one exception: a barrier repair moisturizer with more cholesterol than fatty acids and ceramides can speed barrier repair even faster in older skin types.10 So barrier repair moisturizers for aged skin can have more cholesterol than fatty acids and ceramides and still be effective.

Moisturizers with Ceramides

There are many types of ceramides in skin care products. The skin can make its own ceramides, but ceramide production is reduced in aged skin.11 Ceramides are also important in inflammation, psoriasis and eczema.12 However, you should avoid ceramide-containing moisturizers that do not have fatty acids and cholesterol as discussed above.

What are the best ceramides to look for on moisturizer ingredient labels?

Look for ceramide 1, ceramide 3 or pseudoceramides called hydroxypropyl bispalmitamide MEA or myristoyl/palmitoyl oxostearamide/arachamide mea on the product label. To learn more about the science of ceramides click here.

Moisturizers with Fatty Acids

It is hard to look at the product label to find which fatty acids are in a moisturizer because they go by many names that can be found in oils. To learn more about how to find out what fatty acids are in a skin care product, click here.

What are the best fatty acids to look for on moisturizer ingredient labels?

There are many different things to consider when choosing which fatty acid to use in a moisturizer. In general, stearic acid, linoleic acid and palmitic acid are the most commonly used fatty acids in moisturizers. The best fatty acids to look for depends upon your Baumann Skin Type® and which barriers to skin health you are treating with your skin care routine:

  1. Is skin dry or oily?
  2. Does skin have inflammation?
  3. Does the skin have an uneven skin tone?

Each of these skin issues should be considered when choosing fatty acids in moisturizers

Moisturizers with cholesterol

Many moisturizers have cholesterol. In order for a moisturizer to truly repair the barrier, you must have either:

  1. The same amount of cholesterol as fatty acids and ceramides in a 1:1:1 ratio
  2. Two times as much cholesterol as fatty acids and ceramides in a 1:2:1 or a 2:4:2 ratio

Moisturizers with cholesterol but no (or not enough) ceramides and fatty acids can actually injure the skin barrier by disrupting the natural lipid pattern around the skin cells.

Is there a specific type of cholesterol to look for in barrier repair moisturizers?

The product label will say cholesterol and there is not a particular type to look for. Cholesterol is able to get into the skin because of its hydrophobic lipophilic structure and a membrane transporter called ABCA1 that regulates cholesterol flow into the skin.13

Will cholesterol in skin care products raise my cholesterol levels in my body?

No. Cholesterol molecules stay in the top layers of the epidermis and are not absorbed into the bloodstream.

Barrier Repair creams with retinol

There are no barrier repair creams with retinoids at this time. Using a barrier repair cream before retinol can decrease the penetration of the retinol and decrease side effects. This is a good way to slowly begin using retinol. Once you are used to your retinol, you can apply the retinol first and the barrier repair moisturizer on top. This can help push more retinol into the skin through occlusion.

Will skin barrier repair creams help skin diseases such as eczema?

Do you need a barrier repair moisturizer?

It depends upon your Baumann Skin Type. Take the quiz to see if you need a barrier repair moisturizer in your skin care routine.

References

  1. De Paepe, K., Roseeuw, D., & Rogiers, V. (2002). Repair of acetone‐and sodium lauryl sulphate‐damaged human skin barrier function using topically applied emulsions containing barrier lipids. Journal of the European Academy of Dermatology and Venereology16(6), 587-594.
  2. Park, B. D., Youm, J. K., Jeong, S. K., Choi, E. H., Ahn, S. K., & Lee, S. H. (2003). The characterization of molecular organization of multilamellar emulsions containing pseudoceramide and type III synthetic ceramide. Journal of investigative dermatology121(4), 794-801.
  3. Elias, P. M. (2004). The epidermal permeability barrier: from the early days at Harvard to emerging concepts. The Journal of investigative dermatology122(2), xxxvi.
  4. Mao-Qiang, M., Feingold, K. R., Thornfeldt, C. R., & Elias, P. M. (1996). Optimization of physiological lipid mixtures for barrier repair. Journal of Investigative Dermatology106(5), 1096-1101.
  5. Man MQ, Feingold KR, Elias PM. Exogenous lipids influence permeability barrier recovery in acetone-treated murine skin. Arch Dermatol. 1993;129(6):728-38.
  6. Baumann L. Ch 43 Moisturizers in Baumann’s Cosmetic Dermatology 3rd edition (McGraw Hill 2021) in press
  7. Man, M. Q., Feingold, K. R., & Elias, P. M. (1993). Exogenous lipids influence permeability barrier recovery in acetone-treated murine skin. Archives of dermatology129(6), 728-738.
  8. Mao-Qiang, M., Feingold, K. R., Thornfeldt, C. R., & Elias, P. M. (1996). Optimization of physiological lipid mixtures for barrier repair. Journal of Investigative Dermatology106(5), 1096-1101.
  9. Man MQ, Feingold KR, Elias PM. Exogenous lipids influence permeability barrier recovery in acetone-treated murine skin. Arch Dermatol. 1993;129(6):728-38.
  10. Zettersten EM, Ghadially R, Feingold KR, Crumrine D, Elias PM. Optimal ratios of topical stratum corneum lipids improve barrier recovery in chronologically aged skin. J Am Acad Dermatol. 1997;37(3 Pt 1):403-8.
  11. Jensen, J. M., Förl, M., Winoto‐Morbach, S., Seite, S., Schunck, M., Proksch, E., & Schütze, S. (2005). Acid and neutral sphingomyelinase, ceramide synthase, and acid ceramidase activities in cutaneous aging. Experimental dermatology14(8), 609-618.
  12. Li, Q., Fang, H., Dang, E., & Wang, G. (2020). The role of ceramides in skin homeostasis and inflammatory skin diseases. Journal of dermatological science97(1), 2-8.
  13. https://cdn.mdedge.com/files/s3fs-public/issues/articles/70891_main_0.pdf

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